How the COVID-19 pandemic opened new possibilities for health care at home
While home health care grows from a long tradition, the pandemic spurred Penn Medicine to accelerate an expansion of offerings for patients at home.
Health care at home is nothing new. Midwives have been helping women give birth in their home beds for centuries. The town doctor routinely made house calls. Hospice care, when appropriate, can be given in the familiar setting of a patient’s home, with friends and family around.
While it grows from an old tradition, home care today spans a number of specialties and treatments that are far more complex than imagined in days past. And the COVID-19 pandemic helped spur much more rapid adoption of these advanced treatments than ever anticipated. Among these more recent additions: cancer treatments, which in the U.S. have historically been delivered in outpatient or hospital care settings.
In late 2019, the Penn Center for Cancer Care Innovation at the Abramson Cancer Center and the Penn Center for Health Care Innovation brought together a multidisciplinary team of experts to explore if home cancer treatment could—for appropriate drugs and patient populations—take the place of inpatient or outpatient infusions of chemotherapy and other drugs. They decided to pioneer a new program—Cancer Care at Home—which was the latest of many innovation efforts at Penn Medicine aiming to safely deliver health care in settings that patients found more convenient, at lower cost. The team focused on safety and ensured that the care delivered at home during infusion of cancer drugs was just as safe and effective as administration in the clinic. And they took advantage of the fact that Penn Medicine At Home had cared for patients with cancer for the past two decades—delivering IV fluids and other treatments—even if it was brand new to actually administer cancer drugs in the home.
Very soon after the program’s official launch in February 2020, the COVID-19 pandemic made scaling it a matter of urgency. During the first month of the Cancer Care at Home program before the pandemic arrived, nurses with Oncology Nursing Society certification treated 39 patients with breast cancer, prostate cancer, and lymphoma, who can receive seven different cancer treatments at home.
“Once COVID hit, we had a lot of outpatient areas that were limiting the number of people—if any—who could get into a facility, so we shifted as many treatments as we could into the home setting,” said Joan Doyle, MSN, RN, MBA, CEO of Penn Medicine At Home.
A proving ground for advanced home treatments
When stay-at-home orders were issued in March 2020, Cancer Care at Home was prepared and scaled the program nearly 700 percent—in just six weeks.
“Penn’s Cancer Care at Home program showed that it was safe and effective to receive cancer drugs from the comfort of your own home in a familiar environment, even with your dog sitting right next to you,” said Justin Bekelman, MD, a professor of Radiation Oncology, Medicine and Medical Ethics and Health Policy and director of the Penn Center for Cancer Care Innovation. “The pandemic pushed us to scale up quickly, which helped us truly see how wide this program could go. It’s now a standard of care at Penn Medicine to administer cancer drugs at home for appropriate patients.”
The result is a win not just for patients themselves, but also for the health care system, which operates more efficiently when there’s more capacity to care for those patients who truly need to be in an inpatient or outpatient facility. And it cuts down on costs—for patients and their insurance companies—by shifting care into a lower-cost setting.
No place like home
Penn Medicine seeks to deliver care in the most appropriate setting for each patient's needs. For many patients, we are investing and innovating in more advanced and convenient ways to receive care with the comforts of home.
Keeping hospital beds available for the sickest patients was especially crucial in the first surge of the COVID-19 pandemic. “We were worried that our health system, like many health systems in the country, would be over capacity,” Doyle said. By ramping up home care services, thousands of patients with less-acute COVID-19 infections were able to receive care at home through remote patient monitoring and expanded delivery of things like oxygen and infusions into the home care setting. At the same time, existing and expanded home-care and telemedicine programs helped patients with other conditions receive the care they needed outside of the hospital.
Connecting home care teams to community needs during the pandemic
As part of the pandemic response, Penn Medicine also used partnerships to help its community-based workforce have the most impact and extend to other sites where patients live which might not be customarily thought of as “home.”
For example, an influx of severely ill COVID-19 patients who were nursing home residents in 2020 provided an impetus for Penn Medicine to forge stronger connections with nursing homes, initially in West Philadelphia. Penn Medicine At Home stepped in to sustain health and prevent the need for hospitalization. With grant funding from the state of Pennsylvania, Penn Medicine At Home has expanded its partnerships to 800 long-term care facilities across the region, not only advising on COVID response as it did from the early days of the pandemic, but also working with facilities on quality improvement to improve care for residents and staff satisfaction.
During the COVID vaccine rollout, the health system’s effort to get shots into peoples’ arms in the most convenient places, from churches to recreation centers, also extended into the home. Penn Medicine partnered with the Philadelphia Department of Public Health to give about 5,000 COVID vaccines to people in their homes, many of them home-bound seniors, and became the largest home provider of vaccines in the city.
“Home care has always been possible, but before the pandemic we hadn’t had such a big driver to make this shift in care,” Doyle said.
Editor’s note: This article originally appeared in the Fall/Winter 2022 issue of Penn Medicine magazine in a longer version. It has been edited into four separate parts, covering an overview of home care changes for patients, how the COVID-19 pandemic affected home care services (above), the business growth of home care in the health care industry, and the impact of providing care in patients’ real-world and community settings.